Active NPI
Michelle Jackson, LCSW
- Clinical Social Worker
- Philadelphia, PA
National Provider Identifier
1669798112
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- CW016607
- Practice address
- 4025 Chestnut St FL 1
Philadelphia, PA 19104-3054 - Phone
- (215) 382-6680
- Fax
- (215) 386-1743
- NPI assigned
- Apr 8, 2010
- Last updated
- Apr 8, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | CW016607 | PA | Primary |
Addresses
Primary practice location
4025 Chestnut St FL 1
Philadelphia, PA 19104-3054
Mailing address
4025 Chestnut St FL 1
Philadelphia, PA 19104-3054
Phone (215) 382-6680
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 1, 2017 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CW016607 | PA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270684800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270684800000",
"number": "1669798112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4025 CHESTNUT ST FL 1",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191043054",
"telephone_number": "215-382-6680",
"fax_number": "215-386-1743"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4025 CHESTNUT ST FL 1",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191043054",
"telephone_number": "215-382-6680",
"fax_number": "215-386-1743"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "MICHELLE",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-04-08",
"last_updated": "2010-04-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "PA",
"license": "CW016607",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.